BMJ  2004;328:844 (3 April), doi:10.1136/bmj.328.7443.844

Minerva

Our big brains may have originated in a genetic mutation that evolved 2.4 million years ago. A paper in Nature ( 2004;428: 415-8)[CrossRef][Medline] explains that the mutation, which weakened our jaw muscles, may have changed the shape of our skulls, giving the brain more room to grow.

Nasal squirts of sumatriptan seem to be a good treatment for migraine in children older than 8 years. In a double blind placebo controlled crossover trial of sumatriptan, those who received the drug were nearly twice as likely to experience relief of headache, compared with those who received placebo. The difference occurred within one hour (and was greater at two hours), and was greater in heavier children (> 40 kg), who had a bigger dose. Sumatriptan was well tolerated, and the most commonly reported side effect was a nasty taste ( Neurology 2004;62: 883-7[Abstract/Free Full Text]).

Lots of food groups boost our intake of antioxidants. One team tried to establish how much various foods actually contribute by taking dietary records, and plasma samples, from 61 Norwegian adults. The total intake of antioxidants was about 17 mmol/day, with carotene, tocopherol, and vitamin C contributing less than 10%. Coffee contributed about 11 mmol, fruit 1.8 mmol, tea 1.4 mmol, wine 0.8 mmol, cereals 0.8 mmol, and vegetables 0.4 mmol. The greatest surprise was the impact of coffee ( Journal of Nutrition 2004;134: 562-7[Abstract/Free Full Text]).

Swedish researchers investigating the use of gut-related hypnotherapy in irritable bowel syndrome found, in a randomised pilot study of 28 people with irritable bowel syndrome refractory to other treatments, that hypnotherapy once a week for 12 weeks reduced some of the variables in sensory and motor components of the gastrocolonic response. The authors say that although hypnotherapy has long found its place as a successful treatment of irritable bowel syndrome, its direct impact on the gastrocolonic response might explain a large part of its efficacy ( Psychosomatic Medicine 2004;66: 233-8[Abstract/Free Full Text]).

Many think the worst part of recovering from surgery is getting over the general anaesthetic, which leaves in its wake sedation, drowsiness, fatigue, and lack of energy. Giving the wakefulness promoting drug modafinil, once oral intake could be tolerated after surgery, proved very useful in reducing these symptoms. Greater alertness and energy was reported by 71% of those who took modafinil, compared with 18% of those who received the placebo ( Anesthesia and Analgesia 2004;98: 976-81[Abstract/Free Full Text]).

A new mouse model of breast cancer has been created by successfully grafting human breast cells on to mice, with prior irradiation of some of the fibroblast cells that are transferred with the human tissue. Irradiation encouraged the production of a good microenvironment for the implanted human milk duct cells. The scientists found that outwardly normal breast tissue occasionally developed into hyperplasias (the precursors of cancer)—this, they say, supports the idea that ostensibly normal breast tissue can harbour small islands of genetically abnormal cells that can become cancerous (www.PNAS.org/cgi/doi/10.1073/pnas.0401064101).

Being fulfilled at work is not something to sniff at. Interviews with previously highly paid, high status professionals who opted to become nurses as a second career show yet again that money and status don't necessarily make you happy. A former city lawyer says there's nothing she misses about her former life, and a bank manager says his life began when he hit the wards at the age of 51 ( Nursing Times 2004 March 23: 23-5).

What a shame that inpatient rehabilitation isn't on offer for everyone with chronic arthritis. According to a two year follow up study of people who had been treated at an inpatient rehabilitation centre in Germany, the intervention (involving physiotherapy, group exercise programmes, hydrotherapy, swimming, thermal treatements, massage, and electrotherapy over 3-4 weeks) improved both pain and mobility in the midterm and pain in the longer term ( Annals of the Rheumatic Diseases 2004;63: 360-8[Abstract/Free Full Text]). Minerva thinks such a centre sounds more like a health club than a medical facility.

Hospitals often have modest starts. The Nairobi Hospital officially opened in April 1954. Having built the hospital, the Kenya European Hospital Association had no money to employ specialists—so a radiologist, a pathologist, a pharmacist, and two physiotherapists rented areas around the casualty department, provided their own equipment, and were allowed to charge fees to both inpatients and outpatients ( Nairobi Hospital Proceedings 2003;7: 302-7).

Exercise is hailed victorious in a study that compared percutaneous coronary intervention with stenting with a 12 month exercise regimen in 101 men with stable coronary artery disease. More of those who participated in the exercise programme enjoyed an event-free survival and better exercise capacity at lower costs, mostly due to the reduced need for hospitalisation and repeat revascularisations. To achieve the measured outcomes, $6956 (£3828; 5729) was spent in the percutaneous coronary intervention group, compared with half that—$3429—in the exercise group ( Circulation 2004;109: 1371-8[Abstract/Free Full Text]).

A 35 year old man presented with a four month history of an itchy, scaly rash confined to the palm of his right hand. The skin of his left hand was completely normal. He also had fungal infection of his toenails. Skin scrapings from the right hand confirmed the diagnosis of fungal infection with Trichophyton rubrum grown on culture. The rash cleared completely with a course of oral terbinafine. Fungal infection of the hand (tinea manuum) is usually asymmetrical and quite distinctive. The skin creases are filled with a fine powdery scale and the nails are usually involved. T rubrum is the commonest cause. Unilateral scaling of hands should always alert the clinicians to the possibility of a fungal infection. Sarita Jain, staff dermatologist, Catherine Stephens, consultant dermatologist, Poole Hospital, Poole BH15 2JB

Minerva has mentioned the use of gaseous compounds in diagnosing gut problems in humans ( BMJ 2004;328: 236[Free Full Text]). Now she's read about breath analysis in animals. Samples are easily collected by using face masks or collecting chambers. Giving a ¹³C-labelled compound and subsequently recovering ¹³C in breath can be used to diagnose gastrointestinal and digestive functions. Exhaled hydrogen is useful in assessing orocaecal transit time and malabsorption; exhaled nitric oxide, carbon monoxide, and pentane can be used to assess oxidative stress and inflammation, and exhaled breath condensates to evaluate airway inflammation ( Veterinary Record 2004;154: 353-60[Abstract/Free Full Text])

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